The Honorable John BoehnerSpeakerU.S. House of Representatives1011 Longworth House Office BuildingWashington, DC 20515

Dear Speaker Boehner:

The American Society for Microbiology (ASM), the largest single life science Society with over 38,000 members, is writing to endorse the recent letter sent by the Clinical Laboratory Coalition (CLC) opposing the proposed implementation of Medicare Part B coinsurance on clinical laboratory services as part of the debt ceiling negotiations.

Laboratory test results inform up to 70 percent of all medical decision-making, demonstrating the significant value in health care delivery. Clinical laboratory tests serve as the foundation for the diagnosis, management, and control of infectious conditions such as those caused by HIV, antibiotic resistant Mycobacterium tuberculosis, Bacillus anthracis, Staphylococcus aureus (MRSA), toxigenic and multiply drug resistant E. coli, Salmonella spp., as well as many other serious infectious diseases.

If beneficiary copayment is put in place, laboratories will receive a reduction in their Medicare reimbursement and will then be expected to collect the coinsurance amount from beneficiaries. Collection from beneficiaries will prove impossible in many cases, as laboratories are different than physician practices in that they frequently receive only a Medicare ID number rather than a patient’s full contact information; only receive a specimen and may not interact directly with the patient at all; or provide services to a long term care beneficiary at a nursing facility where most residents are no longer responsible for their own healthcare decision making. Further, in long term care and home care settings, collection of coinsurance is further challenged by the fact that most of these beneficiaries are dual-eligible, meaning they are covered by Medicare and Medicaid, and under existing law, laboratories would be prohibited from collecting their coinsurance amounts from Medicaid.

The additional administrative costs to our health care system of collecting the laboratory coinsurance far exceeds any savings that members of Congress or the Administration believe can be achieved and places the burden for this cost largely on America’s laboratories. At the very least, an adjustment to the Medicare laboratory fee schedule to sustain this increased cost for doing business would be necessary, further increasing health care spending. Otherwise, this situation would be intolerable, particularly for small laboratory businesses, causing many laboratories to limit or drop their participation in Medicare Part B, and therefore, severely limiting access to care for our most vulnerable seniors.

We respectfully request that you work to protect access to clinical laboratory services for Medicare beneficiaries by opposing the implementation of coinsurance for Medicare Part B clinical laboratory services.